Provider Demographics
NPI:1679502009
Name:GENERAL SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:GENERAL SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-781-4267
Mailing Address - Street 1:215 E MANSION ST
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1559
Mailing Address - Country:US
Mailing Address - Phone:269-781-4267
Mailing Address - Fax:269-781-2710
Practice Address - Street 1:215 E MANSION ST
Practice Address - Street 2:SUITE 3E
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1559
Practice Address - Country:US
Practice Address - Phone:269-781-4267
Practice Address - Fax:269-781-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067751174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020A310990OtherBCBSM
MIG5056FOtherBCN
MI383530765005OtherTRICARE
MICH0788OtherRAILROAD MEDICARE
MI020A312720OtherBCBSM GROUP ID
MI0N91940Medicare PIN